Annals of Surgical Oncology

, Volume 25, Issue 6, pp 1616–1624 | Cite as

Adjuvant Chemotherapy Versus Chemoradiotherapy Versus Surgery Alone for Early Gastric Cancer with One or Two Lymph Node Metastasis

  • Su Mi Kim
  • Ji Yeong An
  • Jeeyun Lee
  • Tae Sung Sohn
  • Sung Kim
Gastrointestinal Oncology



Limited studies exist comparing clinical outcomes by adjuvant treatment for pT1N1 gastric cancer. This study compared the disease-free survival (DFS) of patients with pT1N1 gastric cancer according to the type of adjuvant treatment—surgery alone, chemotherapy (CTx), and chemoradiotherapy (CCRTx)—and evaluated risk factors for tumor recurrence.


Between 1995 and 2015, 738 patients underwent radical gastrectomy for pT1N1 gastric cancer and were divided into three groups: surgery alone (n = 355), CTx (n = 214), and CCRTx (n = 169). Chronological changes in adjuvant treatment type and chemotherapeutic regimens were evaluated and DFS was compared. Risk factors for tumor recurrence were analyzed.


The proportion of patients who underwent surgery alone was more than 50% until 2001, and the proportion of those who had either CTx or CCRTx was more than 50% from 2002 to 2011, after which the proportion who underwent surgery alone increased again. The main chemotherapeutic agent was 5-fluorouracil with leucovorin. The 5-year DFS was 96.5% in the surgery-alone group, 96.0% in the CTx group, and 95.8% in the CCRTx group (no significant difference). The various chemotherapeutic regimens did not show differences in DFS. In univariate and multivariate analyses, adjuvant CTx and CCRTx showed no beneficial effect with regard to tumor recurrence.


Because adjuvant CTx and CCRTx did not show any benefit with regard to tumor recurrence, these treatment strategies might be unnecessary for pT1N1 gastric cancer after gastrectomy. Further studies are necessary to reveal pT1N1 gastric cancer patient subgroups who might benefit from adjuvant treatments.



Su Mi Kim, Ji Yeong An, Jeeyun Lee, Tae Sung Sohn, and Sung Kim have no conflicts of interest, financial or otherwise.

Supplementary material

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Supplementary material 1 (DOCX 19 kb)
10434_2018_6434_MOESM2_ESM.tif (104 kb)
Supplementary material 2 (TIFF 104 kb)


  1. 1.
    Lai JF, Kim S, Kim K, et al. Prediction of recurrence of early gastric cancer after curative resection. Ann Surg Oncol. 2009;16:1896–902.CrossRefPubMedGoogle Scholar
  2. 2.
    Japanese Gastric Cancer Assocation. Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer. 2011;14:101–12.Google Scholar
  3. 3.
    Huang B, Zheng X, Wang Z, et al. Prognostic significance of the number of metastatic lymph nodes: is UICC/TNM node classification perfectly suitable for early gastric cancer? Ann Surg Oncol. 2009;16:61-7.CrossRefPubMedGoogle Scholar
  4. 4.
    Cheong JH, Hyung WJ, Shen JG, et al. The N ratio predicts recurrence and poor prognosis in patients with node-positive early gastric cancer. Ann Surg Oncol. 2006;13:377-85.CrossRefPubMedGoogle Scholar
  5. 5.
    Ikeda Y, Saku M, Kishihara F, Maehara Y. Effective follow-up for recurrence or a second primary cancer in patients with early gastric cancer. Br J Surg. 2005;92:235-9.CrossRefPubMedGoogle Scholar
  6. 6.
    Kunisaki C, Akiyama H, Nomura M, et al. Surgical outcomes for early gastric cancer in the upper third of the stomach. J Am Coll Surg. 2005;200:15-9.CrossRefPubMedGoogle Scholar
  7. 7.
    Kunisaki C, Makino H, Kimura J, et al. Impact of lymphovascular invasion in patients with stage I gastric cancer. Surgery. 2010;147:204-11.CrossRefPubMedGoogle Scholar
  8. 8.
    National Comprehensive Cancer Network. National Comprehensive Cancer Network (NCCN) Guidelines (Version 1.2016, Gastric Cancer).Google Scholar
  9. 9.
    Japanese Gastric Cancer Assocation. Japanese gastric cancer treatment guidelines 2014 (ver. 4). Gastric Cancer. 2017;20:1-19.Google Scholar
  10. 10.
    Sobin LH,. Wittekind C. TNM classification of malignant tumors. New York: Wiley-Blackwell, 2009.Google Scholar
  11. 11.
    Macdonald JS, Smalley SR, Benedetti J, et al. Chemoradiotherapy after surgery compared with surgery alone for adenocarcinoma of the stomach or gastroesophageal junction. N Engl J Med. 2001;345:725-30.CrossRefPubMedGoogle Scholar
  12. 12.
    Cunningham D, Allum WH, Stenning SP, et al. Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. N Engl J Med. 2006;355:11-20.CrossRefPubMedGoogle Scholar
  13. 13.
    Ychou M, Boige V, Pignon JP, et al. Perioperative chemotherapy compared with surgery alone for resectable gastroesophageal adenocarcinoma: an FNCLCC and FFCD multicenter phase III trial. J Clin Oncol. 2011;29:1715-21.CrossRefPubMedGoogle Scholar
  14. 14.
    Sasako M, Sakuramoto S, Katai H, et al. Five-year outcomes of a randomized phase III trial comparing adjuvant chemotherapy with S-1 versus surgery alone in stage II or III gastric cancer. J Clin Oncol. 2011;29:4387-93.CrossRefPubMedGoogle Scholar
  15. 15.
    Noh SH, Park SR, Yang HK, et al. Adjuvant capecitabine plus oxaliplatin for gastric cancer after D2 gastrectomy (CLASSIC): 5-year follow-up of an open-label, randomised phase 3 trial. Lancet Oncol. 2014;15:1389-96.CrossRefPubMedGoogle Scholar
  16. 16.
    Tanimura S, Higashino M, Fukunaga Y, et al. Laparoscopic gastrectomy for gastric cancer: experience with more than 600 cases. Surg Endosc. 2008;22:1161-4.CrossRefPubMedGoogle Scholar
  17. 17.
    Yuasa N, Nimura Y. Survival after surgical treatment of early gastric cancer, surgical techniques, and long-term survival. Langenbecks Arch Surg. 2005;390:286-93.CrossRefPubMedGoogle Scholar
  18. 18.
    Waddell T, Verheij M, Allum W, et al. Gastric cancer: ESMO-ESSO-ESTRO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2013;24 Suppl 6:vi57-63.Google Scholar
  19. 19.
    Shin HB, An JY, Lee SH, et al. Is adjuvant chemotherapy necessary in pT1N1 gastric cancer? BMC Cancer. 2017;17:287.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Society of Surgical Oncology 2018

Authors and Affiliations

  • Su Mi Kim
    • 1
  • Ji Yeong An
    • 1
  • Jeeyun Lee
    • 2
  • Tae Sung Sohn
    • 1
  • Sung Kim
    • 1
  1. 1.Department of Surgery, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulKorea
  2. 2.Division of Hematology-Oncology, Department of Medicine, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulKorea

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